Agua1967

I'm on a SI for Afib. How much trouble would it be to
Add a beta blocker for annoying PVC'S. I get less than 500 a day
verified by Zio/Holiter that FAA has approved. Will FAA require a new full
Work-up? Or will they be happy with 7 day wait and report on next Medical?

Xdashdriver

Fantastic question for an AME?

AirBear

Yep, better run this by an AME or one of the Aeromedical Advisory services. From my experience with my 17 year fight with diabetes almost any type of medication addition or change will require a grounding period of a few weeks up to 60 days. Your AME may be able to waive the period down to the minimum. But I'm not familiar with Beta Blockers. AMAS ( https://www.aviationmedicine.com/ ) is really good and is covered by many airlines, charter, and fractional outfits. That website has a medication database where you can check out what meds you want and see what's required.

WhisperJet

The real question is how your SI letter is interpreted. Usually it says something to the effect of any change in medication or treatment requires notifying the region, but beta blockers for a separate issue, in your case, PVCs, is more of a gray area since it’s not technically related to your AFib. I bet if you asked 4 AMEs, you would get four different answers. My suggestion would be to discuss with AMAS and your regular AME, and if in doubt, call your Regional office and ask. you could also play it ultra conservatively and do a self disclosure of the new medication to the regional office followed up with a phone call and get a letter from them which you can bring to your next regular physical. But my advice is worth what you paid for it so please check with the professionals.

Agua1967

I called AME. He's giving me direction on what needs to be done.
Should have made the call before posting.

WhisperJet

What did the AME say? Any info would probably help a lot of people in your same Situation.

Dubh

Good call.
As stated above, the free advice that you get on here is worth exactly what you paid for.

FltChk

I have a SI for AFib as well. I’m thinking you’ll have to contact the branch manager or FAA regional flight surgeon per the Authorization letter

“You must promptly report any adverse changes i n your medical condition or new symptoms, or any side effects from medication or changes to your medication,
to the Branch Manager at the above address or your FAA Regional Flight Surgeon.

You are cautioned to abide by Title 14 of the Code of Federal Regulations (CFRs), Section 61.53, relating to physical deficiency. Because of your history of atrial fibrillation, operation of aircraft is prohibited at any time new symptoms or adverse changes occur or if you experience side effects.”

JohnBurke

When a medical certificate is issued, it's predicated on two things: your condition at the time of issuance, and what you can reasonably be expected to be, for the duration of the certificate level issued. That is, are you medically airworthy at the time of issuance, and can you expect to be so for the time period encapsulated by the certificate? Any chances to your condition subsequent to issuance have a direct bearing on the efficacy of the medical certificate. For example, if you are issued a medical certificate today, but a week from now experience a heart attack, obviously you are no longer medically fit to the standard of the certificate, and even though you have a medical certificate in your wallet with ample time remaining, it is no longer valid for you, in your present condition. If you have a temporary condition that makes you medically unfit, you are temporarily medically disqualified. If you operate during a period when you are not medically fit, or in other words, when your medical is invalid because you do not meet the standards or conditions of issuance, then you are in violation of the regulation just the same as if you had no medical certificate (because it's not legally valid if you're not fit). This has always been the case.

What that comes down to for those who fly with a headcold or other temporary condition, is how lucky they feel, and whether they get caught.

A special-issuance medical certificate is based on particular criteria established for that issuance. Based on medical facts presented to the Administrator and designated representatives, the medical is issued contingent on the applicant meeting and living within those facts. If the special-issuance is based on a particular medication intake, or particular dosage, then changing the dosage without amending the special issuance, makes that special-issuance medical certificate invalid. Again, if you don't meet the standard of your medical certificate as issued to you, then it's not legally valid for you to operate, during the time you are outside those standards. If your medical certificate were to say you must wear blue to fly and you choose to wear pink, then you're grounded until you choose to wear blue again. It's that simple. Change the medication, and you'll either need a new special issuance, approval to operate under the current issuance with the new medication or dosage, or you're grounded because you're now outside the conditions for which the special issuance was given.

This is sometimes confusing, because in most cases, we're not required to report a given condition, until our next physical. Some mistakenly believe that we can have any condition occur once we're issued the medical, and we're golden until we go back in for our new medical. This is false . You're required to report the new condition at your next medical, but if you have a medically disqualifying condition now, and your next medical exam is four months from now, you're grounded now. You'll have to report it in four months.

If you have four months remaining on your special issuance, but you elect to take a higher dosage or a different medication, even under medical supervision of your personal physician, then you are still outside the terms and conditions upon which your medical certificate special issuance was given, and must either decline operating (as it's no longer valid), obtain a new issuance, or gain approval/amendment of your existing issuance based on the changes you are undergoing. The first step, as noted previously in the thread, will be to go through your AME. Your AME may be able to quickly determine that a range of medical dosage is acceptable, and you fall within the range, or may be able to determine that documentation of your new dosage must be submitted to Oklahoma City, for approval.

WhisperJet

You could also self report to the regional office with all the necessary documentation and assuming you’re better, hopefully have an updated authorization letter in hopefully a couple weeks and bring that to your next appointment.